Technologies arrive on the market in New Zealand and we snap them up frequently without looking into safety profiles, indicated and registered uses, or classification of the devices which can scar, burn and traumatise our clients. We watch a Youtube video or two, we listen to the spiel from the sales rep and then we get started with the training from the supplier. What could possibly go wrong?

When we investigate a technology we look at the following areas: What is is? Where does this technology come from, and what has it been approved for? What medical indications is it approved for? (TGA, FDA, Medsafe etc..), and what are the contraindications, who cannot or shouldn’t have it done, as well as considering any restrictions on who should operate the technology based on the above investigations and observations of reported adverse (unwanted) side effects or incidences we know of.

We have recently investigated Plasma – not the yellow serum that is left after taking out the whole red blood cells, known as platelet rich plasma, but the 4th state of matter known in physics and science worlds as ‘Plasma energy’. This is the latest craze sweeping the globe in the desperate search to look younger, firmer and less wrinkled. This is a gathering of our findings, you may have investigated this yourself too? – well these are our opinions, findings and recommendations…

What is plasma? – It is the 4th system of matter after solid, liquid, and gas – once the atoms within a gas molecule are stripped of their electrons they turn into ions, and this is what plasma is. Or in other words plasma is ionised gas. In nature you will see plasma in the way of lightning, the sun (as a giant ball of fiery plasma), the northern lights (which is plasma being influenced by the electromagnetic fields around the earth) – man made sources of plasma include the fluorescent lightbulb, neon light signs, and plasma televisions. When plasma is created, the colour it emits will be determined by the gas medium it is based on or created by. Argon gas will produce a purplish glow, whereas nitrogen gas emits a reddish orange glow and so on.

What property of plasma are we utilising in the beauty and aesthetic industry? The particles within the plasma itself will start to break down, or erode the surface it is in contact with, in this case the skin surface or epidermal cells. This is an important point because when plasma is used on the skin, manual pressure, length of exposure time and degree of power or energy emitted will determine either a superficial removal of skin cells, or a nasty coagulated burn that could go full thickness into the skin. Also referred to as “Fibroblast Therapy” – due to the creation of extracellular matrix and collagen production after micro injury response in the skin.

What concerns do we need to consider when using plasma?
If your client has a darker skin type (FP V- VI), the plasma will not be chromophore specific, it will heat everything in its path, it is not looking only for a single; or multiple chromophores, like laser or IPL does. So, if your clients skin has more melanin, we would expect that plasma could damage the melanocyte and cause potential hyper, or hypo pigmentation. If the client’s skin is prone to scarring, or they have ever had injections or medication for arthritis (Called gold therapy), they cannot have this treatment. The same goes for reduced skin function from drugs such as isotretinoin, or blood thinning medication. Other contraindications should include: active acne, infection at the site, pregnancy or breast feeding, presence of skin cancers, including melanoma, and those with immune disorders or diseases. (Lupus, vitiligo, psoriasis). – Other contraindications might exist but not be available yet.

What are regulations are in place in New Zealand for Plasma devices?
Currently Medsafe do not recognise these device as medical devices, anyone can buy them and sell them to you, and anyone can use them. As they are not technically lasers, the current bylaw restricting beauty services in Auckland (Auckland health & Hygiene bylaw 2013) does not cover this treatment technology. However, depending on what happens in the review process of the related code of practice, guidelines be revised to cover this, and other related technology.

We were unable to find FDA / TGA or Medsafe approval on any plasma skin pen device.

What safety eyewear or PPE (personal protective equipment) is required when working with plasma?
Plasma is not technically a light source, so therefore no safety glasses are required. Operators may like to consider wearing protective face masks of <0.1microns to prevent against inhalation of treated skin cells, that could include HPV (human papilloma virus), bacteria and smoke like toxins that could potentially be formed as part of the use of plasma on tissue.

Is numbing cream required?
Some operators of plasma devices are applying topical aesthetics which, in NZ are mostly prescription only. A small tube of Emla cream (containing: Prilocaine 2.5%, Lidocaine 2.5%) can be purchased through pharmacy, or online and must be occluded to make it effective (covered with gladwrap for between 30-45 mins). Other topical preparations including xylocaine, tetracaine, lidocaine may be used however caution should be considered as strengths vary and
overdosed areas may cause anaphylactic shock and even death. Please check the Pharmacokinetic properties of the product you intend to use, and abide by the restrictions on access to, and use of them as they are restricted for a good reason.

What is involved in the application of plasma?
On clean skin, that has been suitably prepared, a tiny pin like probe is applied delivering micro pulses to the skins surface (like little bolts of lightning), these will leave an instant mark and the technique used is to trace along the wrinkles themselves rather than work to origin and insertion points of muscles. Essentially whatever area they desire the improvement, whether that be laxity of skin on the stomach- post baby, around the orbital rim, crow’s feet or even over the eyelid itself, as well as neck, and cheeks.

What cautions should be taken into consideration when selecting the right candidates for plasma treatments?
There is considerable ‘social downtime’ involved with plasma treatments, upwards of 6-8 weeks to reach full healing, potentially. This includes looking spotty and dotty, and scabby in treated areas. It involves a dry wound healing process so as long as the skin is not disrupted beyond the superficial epidermis, no open wounds should be expected. Clients who have raised veins, crusty scaly skin lesions, or vascular abnormalities should not be treated. Treatment over bony prominent areas should be done with caution due to increased risk of burns. Clients who are going to undertake the plasma procedure for cosmetic benefit, should be fully consulted about potential scarring, burns, uneven result, transient erythema, and prolonged crusting which may interfere with day to day presentation (i.e.: will they want to go to work looking like this?)

A signed informed consent form should be obtained before proceeding with the treatment, and clients should be monitored for any adverse reactions, or changes in the skin for at least 48-72 hours following the procedure, this may include the occurrence of swelling, heating, redness or pain, and oozing in treated areas. Clients should also be informed not to open their eyes during the treatments over eyelids as the plasma would adversely affect the cornea (the front gel coating over the eyeball) – which could cause a thermal injury.

(Reference sources: Youtube: The science verse, and The lab of plasma processing – Maryland, USA, Jill best aesthetics UK) we also spoke with various suppliers, watched training videos and researched articles on plasma in order to prepare this article.

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